Health financing for universal coverage

Benefits and rationing

Decisions about which services to include in a benefit package are also decisions about which services exclude. By clearly defining which services are covered by the benefit package, and for whom, we also identify those services not covered. All countries, whether rich or poor, limit service entitlements one way or another. This is called rationing, and decisions about how to ration benefits influences health system performance in terms of universal health coverage (UHC) goals.

All public and private healthcare systems ration patient access to health care. The private sector rations access by charging market prices to patients, with demand driven by a person's ability and willingness to pay. Public systems generally ration care on the basis of a patient’s need, for example by covering priority cost-effective treatments, and through the use of waiting lists. Patients may also be asked to make a co-payment.

Promoting UHC through benefit package design

A number of countries have made changes to the entitlements defined in their benefit packages in order to make progress towards UHC. In Chile, for example, the publicly funded AUGE programme (Universal Access with Explicit Guarantees) includes four guarantees for a number of high-mortality conditions.

Aligning the benefit package with health financing functions

It is critical that the entitlements defined in a benefit package are delivered effectively within the fiscal constraints facing governments. A large mismatch between what is promised and what is delivered can seriously undermine a government's credibility in the health sector, and limit progress towards UHC. In such cases, rationing will start to occur implicitly, for example through increased unofficial payments, or poor quality of care due to a lack of medicines. Ensuring adequate revenues, minimal fragmentation in pooling arrangements, and effective purchasing mechanisms are all critical to ensuring that coverage is effective and the health system makes progress towards UHC.